Background: Measles is a highly contagious and a vaccine-preventable disease. On 14 August 2015, a measles outbreak was reported in Langkat District, North Sumatra province of Indonesia. To investigate the risk factors of the outbreak and to recommend control measures, an epidemiological investigation was undertaken. Method: A 1:1 matched case-control study was conducted. All suspect and confirmed cases were recruited and included. Controls were healthy neighbors of cases, matched for age and gender. House-to-house search for cases was carried out. Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. A two-step logistic regression was employed to assess the potential risk factors associated with the infection. Results: During 20 July to 25 September 2015, a total of 28 measles cases were identified with no death. All tested blood samples were positive for measles-specific IgM antibodies confirming the outbreak. All cases presented with fever and rash; cough (80%), coryza (65%), and conjunctivitis (25%). The attack rate (AR) was 14.1% (age ranged between 1 and 14 years old), the highest AR (50.0%) occurred among those aged 1-4 years. In multivariate model, those who have not received measless vaccication and those who had contact with a measles case had higher odds of having infection, with adjusted odds ratio (aOR): 2.31 (95%CI: 1.22-4.27) and aOR: 1.15 (95%CI: 1.12-3.70), respectively. Conclusions: Being unvaccinated and having a contact history increased the risk of measles are two risk factors of measles infection. A mass measles immunization to the school children was undertaken and a strict measles surveillance and notification system were recommended to control the transmission in the future.

BACKGROUND: Our world is now facing the public health emergency situation. Since early December 2019, COVID-19 emerged the Wuhan City, Hubei Province, China. The disease is still continuing spread to more than 200 countries and territories globally. AIM: This study aimed to assess the knowledge of COVID-19 among the surveillance officers and outbreak investigation team in North Sumatera, Indonesia. METHODS: A cross-sectional study was performed between March 5, 2020 and April 20, 2020, among the surveillance officers and outbreak investigation team in North Sumatera province, Indonesia. A set of validated, pre-tested questionnaire was used to measure knowledge regarding COVID-19 infection and to collect a range of explanatory variables. Data were collected through a self-administered questionnaire. A two-step logistic regression analysis was employed to assess the association of participants’ demographic data, level of education, surveillance training, length of work, and location of workplace with the knowledge. RESULTS: A total of 246 participants were collected. We found that 109 out of 246 (44.3%) participants were good knowledge of COVID-19. Multivariate model revealed that surveillance training was the most associated variable with knowledge of COVID-19 (OR = 2.15, 95% CI = 1.09–4.27). In addition, as much as 27 participants (79.4%) have good knowledge and also have received surveillance training expressed a willingness to conduct surveillance (OR = 4.75, 95% CI = 1.98–11.39). CONCLUSIONS: The knowledge of surveillance officers and outbreak investigation team in North Sumatera regarding COVID-19 is relatively low. Participants who have good knowledge and have received surveillance training expressed a willingness to conduct surveillance of COVID-19 in the community. Therefore, training for surveillance and outbreak investigation team to improve the understanding and skill is a must.

Background: Chikungunya is a vector-borne infection with high morbidity rate and associated with debilitating prolonged polyarthritis and substantial socioeconomic impact. On 4 January 2010, a chikungunya outbreak was reported in Sukadana Subdistrict, West Kalimantan, Indonesia. Objective: An epidemiological investigation was conducted to identify the risk factors for the outbreak and recommend control measures. Method: A case-control study was conducted to identify the risk factors of the outbreak. The cases were residents who had major clinical symptoms of chikungunya that were identified by active case finding through the affected area while controls were neighbor of the cases. Interviews were conducted to collect demographic and clinical data as well as the risk factors of infection. The venous blood from ten patients, selected randomly, were collected and tested for diagnosis confirmation. Results: During 12 December 2009 and 10 January 2010, a total of 65 chikungunya cases were identified with no death. Seven out of ten blood samples were confirmed as chikungunya cases. All of the patients had fever, rash and arthralgia while headache was reported in 43% of the cases. The attack rate was 17.3% (range 3.9-22.6%) and those aged > 44 year old had the highest attack rate. In multivariate model, those farming in the forest and those who had poor practices in eliminating mosquito breeding sites had higher odds of having chikungunya, with adjusted OR: 10.66 (95%CI: 3.95-28.79) and adjusted OR: 3.51 (95%CI: 1.35-9.13), respectively. Conclusions: Farming in the forest and poor vectors control are two risk factor of chikungunya infection. Therefore, using anti-mosquito repellent when farming and continuous and coordinated mosquito breeding sites elimination are recommended.

BACKGROUND: Diabetic neuropathy reduces the patient’s quality of life and the quality of diabetes management itself and, as a result, worsens the prognosis of other diabetic complications. Various complaints that are often felt by diabetes mellitus (DM) patients due to neuropathy include pain in the legs, numbness, and weakness in the affected leg, paresthesia, or numbness, and the absence of tendon reflexes in the affected leg. AIM: This study aimed to determine the effectiveness of electric massage therapy on neuropathy healing in DM patients. METHODS: The pre-test and post-test experimental design without a control group was employed. Patients with neuropathy diabetic were recruited as the subject of the study. The total number of participants in the study was 30 people. All the subjects were assessed for neuropathy using the neuropathy assessment instrument and the monofilament test. The Kolmogorov–Smirnov test was employed to analyze the normality of the data. The Wilcoxon signed-rank test was employed for non-normally distributed data. The study used a 95% confidence interval, and significance was assessed at alpha <0.05. RESULTS: Mean difference test resulted that the Z value was −4.791; (p < 0.01). These results indicate that there was a statistically significant difference in the level of neuropathy before and after the massage therapy intervention. CONCLUSIONS: Foot massage therapy has a significant effect in reducing the complaints of diabetic peripheral neuropathy (DPN). It is recommended for the DPN patients to conduct foot massage independently regularly as an alternative treatment in-home care treatment.

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Rabies merupakan masalah kesehatan masyarakat di Sumatera Utara. Tujuan dari program pencegahan dan pengendalian rabies adalah untuk mencapai Sumatera Utara bebas rabies tahun 2020. Penelitian ini merupakan penelitian observasional dengan desain cross sectional dengan mengumpulkan dan menganalisis laporan bulanan dan tahunan kasus rabies di Sumatera Utara sejak tahun 2007-2017. Evaluasi dilakukan terhadap seluruh proses program pencegahan dan pengendalian rabies. Hasil didapatkan bahwa pelaksanaan program pencegahan dan pengendalian rabies di Sumatera Utara belum berjalan optimal, seperti pelaksanaan surveilans epidemiologi, pelacakan kasus, tata laksana kasus di fasilitas pelayanan kesehatan, masih kurangnya partisipasi masyrakat, kurangnya rabies center di kabupaten/kota, serta kurangnya kerja sama antara dinas kesehatan dan dinas peternakan kabupaten/kota. Program pencegahan dan pengendalian rabies di Sumatera Utara belum berhasil dalam menurunkan kasus lyssa, masih terdapat 9 kabupaten/kota yang selama 2 tahun terakhir memiliki kasus lyssa. Disarankan lebih meningkatkan kerja sama lintas sektor dan program untuk mencapai Sumatera Utara bebas rabies 2020.

BackgroundChikungunya fever is a vector-borne disease with high morbidity rates, prolonged polyarthritis in some cases and it cause substantial socioeconomic impact. On 4 January 2010, an outbreak of Chikungunya fever was reported in West Borneo in Indonesia. The total number of cases was 65 with no fatalities. An analytical study was undertaken to determine the risk factors for the outbreak.MethodThis was an observational study with case control design. Cases were those with major clinical symptoms of Chikungunya fever, such as fever, arthalgia, myalgia, rash and headache. Controls were neighbours of cases who did not have clinical symptoms of the disease. The study used bivariate and multivariate analyses with χ2 and logistic regression. OR was used to determine risk factors. Some patient's blood was tested to confirm the diagnosis.ResultsFrom the bivariate analyses, risk factors were farming in the forest (p value <0.05, OR=10.14, 95% CI 3.84 to 26.76); not using mosquito repellent devices (p=0.001, OR=4.70, CI 1.75 to 12.60); not eradicating mosquito nests (p=0.007, OR=3.18, CI 1.33 to 7.61); and hanging clothes (p=0.015, OR=2.814, CI 1.206 to 6.566). The multivariate analyses showed that farming farming in the forest was an independent risk factor for infection (Exp.(B): 9.122, p<0.05). Laboratory examination of blood samples confirmed that two out of four cases were positive for Chikungunya fever.ConclusionsFarming in the forest was a risk factor for infection. This was the basis for health promotion and prevention of future cases of Chikungunya fever in West Borneo.